Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Case Self-Management

When an injury is such that the worker cannot go back to the job he has held for many years., but he does track his treatment, keeps meticulous records of the course of his care, the opinions, the lab studies, the procedures and his medications. He is very thorough. But there is a concern:

“What is this patient currently doing that creates a viable future for himself and his family, or is he, in fact, merely spinning his wheels?”

Patients without clear options, while failing to create future goals for themselves, can get lost in the role of being their own care manager.

Taking on this role is a frequently just a defense…a distraction. It keeps them from addressing the more frightening reality of needing to be retrained or re-educated for a new career within the limitations created by their injury.

Looking at an uncertain future is daunting if not quite terrifying to many patients. It is very easy to avoid the things which frighten us most. It is, obviously, easier to mow the lawn than it is to deal with a cracked foundation. And most often these patients have no foundation upon which to built a viable future.

I recommend that rather than seeing a patient’s efforts at becoming their own case manager as a form of heroism that you instead also note when this becomes a way to avoid the more important task of selecting a path toward the future.

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